Healthcare Provider Details

I. General information

NPI: 1093418691
Provider Name (Legal Business Name): APARNA SETHUMADHAVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 TOWN PLAZA AVE STE 105
PONTE VEDRA BEACH FL
32081-5179
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1053
  • Fax: 904-427-8595
Mailing address:
  • Phone: 904-383-1053
  • Fax: 904-427-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME181874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: